Newborns sometimes need support adapting to life outside the womb. While most babies transition smoothly, some require medical assistance to establish stable breathing and circulation immediately after birth. Positive pressure ventilation (PPV) is a common method used in these situations.
Understanding Positive Pressure Ventilation
Positive pressure ventilation (PPV) is a medical technique that helps newborns breathe by gently delivering air into their lungs. Its primary purpose is to inflate the baby’s lungs and establish effective breathing when they are not doing so on their own. This method is a supportive measure, assisting the baby’s natural respiratory efforts.
PPV involves pushing air into the lungs using controlled pressure, which helps to expand the tiny air sacs (alveoli) and clear any fluid from the womb. This process facilitates gas exchange, allowing oxygen to enter the bloodstream and carbon dioxide to be removed. It is a key part of neonatal resuscitation, aiming to minimize potential lung and brain injury.
Situations Requiring PPV in Newborns
Newborns may require PPV when their breathing is insufficient or absent at birth. This intervention is indicated if a baby is not breathing, is gasping, or has a heart rate below 100 beats per minute (bpm). Approximately 10% of newborns may need respiratory support immediately after delivery.
These issues often arise during the transition from the fluid-filled environment of the womb to breathing air. Conditions such as poor muscle tone or an abnormal color can also indicate a need for respiratory assistance. PPV is a common procedure in neonatal resuscitation, which helps newborns struggling to breathe or with a slow heart rate.
Administering PPV to Newborns
The administration of PPV to newborns is performed by trained medical professionals. A mask is placed over the baby’s nose and mouth, creating a seal to deliver controlled breaths. This mask is connected to a device (e.g., a self-inflating bag, a flow-inflating bag, or a T-piece resuscitator) which allows caregivers to regulate the pressure and frequency of air delivery.
The ventilation rate is set at 40 to 60 breaths per minute, with initial pressure ranging from 20 to 25 cm H2O for term infants. Medical teams (nurses, doctors, and respiratory therapists) monitor the baby’s response, observing for an increase in heart rate and visible chest movement. If the heart rate does not improve within 15 seconds, adjustments to the mask seal, airway position, or pressure are made.
Newborn Care After PPV
After a newborn receives PPV and begins breathing effectively, close monitoring continues for a stable transition. Medical staff observe the baby’s heart rate, oxygen levels, and breathing effort to confirm sustained improvement. Many infants who receive PPV recover quickly, integrating into routine newborn care.
While some babies may experience short-term fussiness, the long-term outcomes for most newborns who receive PPV are favorable. Infants who receive PPV, even for short durations, may have a higher chance of neonatal morbidities and might require special care measures. NICU admission is more common for infants who receive PPV compared to those who do not. This post-resuscitation care often involves observation in a special neonatal care unit for at least six hours, regardless of the duration of PPV, to monitor for any potential complications.